References
Patient safety in anaesthesia
Abstract
Anaesthesia is a complex process resulting in numerous steps in the assessment of veterinary patients, preparation of drugs and equipment, checking of the equipment and communication between team members at several points. It is imperative that within this veterinary professionals strive to ABOVE ALL uphold their declaration to ‘ensure the health and welfare of animals committed to their care’. The pursuit of patient safety in veterinary anaesthesia is in its infancy but must strive to reduce the gap between best practice and the care currently delivered in veterinary practices. This has to involve an evidence-based approach to veterinary anaesthesia and a realisation that preventable human errors occur every day. It must be recognised that not only do these errors occur but that they are inevitable and that only by the recognition and reporting of these errors can analysis and reflection occur to offer preventative strategies. By using veterinary specific tools such as checklists and reporting systems, weveterinary nurses can make a difference.
For some time now it has been known that the mortality rates associated with anaesthesia in small animal patients are much higher than in human medicine (Brodbelt et al, 2008; Mellin-Olsen et al, 2010; Bainbridge et al, 2012). There has been a vast improvement over the last 20–30 years which has largely been prompted by advancements in monitoring methods and equipment, pharmacological advances and better understanding of the subject allowing better education and professional development (McMillan, 2014). Indeed the risk of anaesthetic-related mortality in a healthy (American Society of Anesthesiologists Physical Status Classification I-II) dog reduced from 0.11% to 0.05% between 1980 and 2003 (Clarke and Hall, 1990; Brodbelt et al, 2008). Despite this reduction the level of anaesthetic fatalities demonstrated by The Confidential Enquiry into Small Animal Fatalities (CEPSAF) fall far below those observed for human anaesthesia in both developed and developing world countries which were 0.000018% and 0.00012% respectively for the period 1990s to 2000s (Mellin-Olsen et al, 2010; Bainbridge et al, 2012). CEPSAF shows an overall risk of anaesthetic death (within 48 hours of the procedure) in small animal patients as: dogs 0.17%, cats, 0.24% and rabbits, 1.39% with post-operative deaths accounting for 47% of the deaths in dogs, 61% in cats and 64% in rabbits (Brodbelt et al, 2008).
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